Leptomeningeal Metastasis
Leptomeningeal Metastasis
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DOI：
10.1055/s-0030-1255220
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发表时间：
2010-07-01
影响因子：
2.7
通讯作者：
Chamberlain, Marc C.
中科院分区：
文献类型：
--
作者：
Chamberlain, Marc C.
软脑膜转移发生在所有癌症患者的5%左右，是中枢神经系统第三大常见的转移性并发症。软脑膜转移的分期包括对比增强的脑和脊柱磁共振成像和放射性核素脑脊液（CSF）流动研究。当有临床指征时，治疗通常需要对体积大或有症状的疾病部位进行受累野放疗以及CSF内和全身化疗。使用大剂量全身性治疗可能使乳腺癌或淋巴瘤相关的软脑膜转移患者受益，并减少CSF内化疗的需要。CSF内药物治疗主要利用三种化疗剂之一（例如，例如，在一个实施例中，甲氨蝶呤、阿糖胞苷和噻替派）通过腰内或脑室内药物递送的多种方案给药。开始使用的是新型CSF内药物，如靶向单克隆抗体利妥昔单抗（抗CD 20，用于B细胞淋巴瘤相关的软脑膜转移）和曲妥珠单抗（抗Her 2/neu，用于乳腺癌相关的软脑膜转移）。虽然软脑膜转移的治疗是姑息性的，患者的中位生存期为2至3个月，但治疗可以为软脑膜转移患者提供稳定和保护，使其免于进一步的神经系统恶化。
Leptomeningeal metastasis occurs in similar to 5% of all patients with cancer and is the third most common metastatic complication of the central nervous system. Staging of leptomeningeal metastasis includes contrast-enhanced brain and spine magnetic resonance imaging and radionuclide cerebrospinal fluid (CSF) flow study. Treatment, when clinically indicated, often requires administration of involved-field radiotherapy to bulky or symptomatic disease sites as well as intra-CSF and systemic chemotherapy. The use of high-dose systemic therapy may benefit selected patients with breast- or lymphoma-related leptomeningeal metastasis and obviate the need for intra-CSF chemotherapy. Intra-CSF drug therapy primarily utilizes one of three chemotherapeutic agents (e. g., methotrexate, cytosine arabinoside, and thiotepa) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Beginning to be utilized are novel intra-CSF agents, such as the targeted monoclonal antibodies rituximab (anti-CD20 for B-cell lymphoma-related leptomeningeal metastasis) and trastuzumab (anti-Her2/neu for breast cancer-related leptomeningeal metastasis). Although treatment of leptomeningeal metastasis is palliative with median patient survival of 2 to 3 months, treatment may afford stabilization and protection from further neurologic deterioration in patients with leptomeningeal metastasis.